Circulating Tumor DNA May Predict Postsurgical Breast Cancer Relapse

Author(s):

Alex Biese

Fact checked by:

Spencer Feldman

Key Takeaways

ctDNA can predict breast cancer relapse up to 38 months before clinical signs, with 88.2% accuracy in relapsed patients.
Presence of ctDNA is linked to shorter relapse-free and overall survival, highlighting its prognostic value.
Serial ctDNA analysis allows earlier recurrence detection than imaging, especially in aggressive breast cancer subtypes.
Negative ctDNA tests in HR+ patients don't eliminate relapse risk, requiring repeated tests for confirmation.

For some patients with breast cancer, ctDNA may have the potential to predict disease relapse after they have undergone surgery and chemotherapy.

Circulating tumor DNA (ctDNA) may be a valuable tool for predicting the risk of breast cancer relapse after surgery and chemotherapy.

This image was generated using AI.

Circulating tumor DNA (ctDNA) may be able to potentially predict disease relapse for patients with breast cancer following surgery and chemotherapy, researchers have found.

Researchers showed, in study findings published in JCO Precision Oncology, that among 156 patients with primary breast cancer who were monitored for up to 12 years after surgery and adjuvant (postsurgical) chemotherapy, personalized Signatera tests were able to detect ctDNA prior to clinical or radiologic relapse among 30 of the 34, or 88.2%, of patients who relapsed.

Relapse was predicted up to 38 months in advance of occurrence, the findings showed. Furthermore, the presence of ctDNA was also associated with shorter relapse-free survival (the time a patient lives without any signs or symptoms of disease) and overall survival (the time a patient lives, regardless of disease status), researchers stated.

“Serial postoperative ctDNA analysis has strong prognostic value and allows for earlier detection of recurrence than by scans in many patients, while repeated negative tests can provide assurance to patients,” researchers concluded in the study. “This provides a potential window that could enable the design of trials to assess the impact of earlier therapeutic interventions, which may lead to improved clinical outcomes, particularly in the setting of more aggressive subtypes (i.e., [triple-negative breast cancer]).”

All four of the patients who had negative ctDNA tests prior to experiencing relapse had hormone receptor-positive (HR+) disease. But, on the other hand, five of the 122 patients who did not relapse, all of whom had HR+ disease, had occasional false positive tests.

“For patients with HR+ breast cancer, who remain at risk of relapse for many years, a negative test does not rule out the possibility of relapse, and for those where ctDNA is detected, a repeated Signatera test may be needed to confirm a positive test,” researchers wrote. “In particular, confirming ctDNA concentration increase in subsequent tests might be more informative. Earlier intervention opportunities may allow better and more timely treatment with switch of endocrine therapy, but properly controlled randomized studies will be needed to determine if this is the case.”

All told, researchers summarized, “our results suggest that ctDNA testing may add to existing recommendations for symptom assessments, physical examination and routine breast imaging as a means of monitoring patients with breast cancer after completion of definitive local therapy with or without adjuvant chemotherapy.”

Reference

“Serial Postoperative Circulating Tumor DNA Assessment Has Strong Prognostic Value During Long-Term Follow-Up in Patients With Breast Cancer” by Jacqueline A. Shaw, et al., JCO Precision Oncology.

All of the cells in the body secrete cell-free DNA into the circulatory system, and clinicians can check for ctDNA — the cell-free DNA released by cancer cells — via a blood draw known as a liquid biopsy, as Dr. Ben Ho Park, director of the Vanderbilt-Ingram Cancer Center in Nashville, explained to CURE® earlier this year.

“Rather than going after a solid tumor and putting a needle in there, you can just get a tube of blood and get some of that genetic information — recognizing I'm saying some, because you can't necessarily get all — and the other advantage is you can do serial blood draws fairly easily compared to serial tissue biopsies,” Park explained.

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